Hydatidosis (HD) is an ancient disease and even was known to Hippocrates. It can virtually affect any organ within the body from head to toe, and also the most typically affected organs are found to be the liver and lungs [1]. The occurrence of Echinococcosis at unusual sites is approximately 8-10%. Hydatidosis is a significant pathological state within the infested areas of the globe, mainly in sheep-raising communities. But attributable to increased travel and tourism worldwide, it is often found anywhere, even in developed countries [2]. It can involve any organ and mimic almost any pathological condition. The clinical picture depends upon the involved organs, their effects on adjacent structures, complications because of secondary infection, rupture, and anaphylaxis caused by hydatid cysts [3].

The first asymptomatic phase and delayed presentation make early diagnosis difficult. The varied complications of the disease, instead of the disease itself, are tougher to treat. The infection might undertake a 'malignant' course within the sense of a high rate of recurrence, which further enforces the importance of meticulous evaluation and proper planning of treatment and better preventive methods aiming at control and eradication of this age-old disease [4].

Further studies are therefore needed to enhance our understanding of the varied clinical problems caused by this parasite generally and more specifically to reassess the surgical nature, complications, and fatality of this disease to use a more appropriate surgical procedure to human Echinococcosis [5]. Surgery for infestation has always been considered because of the gold standard in terms of therapy despite significant advances in medical treatment and interventional radiology [6]. With time, the treatment for abdominal infestation is undergoing revolutionary changes. The era of open surgery with its associated large incision and prolonged stay is now being challenged by lesser invasive procedures [7]. With the evolution of laparoscopic surgeries, laparoscopic treatment of infestation has also evolved [8]. Hydatid cyst may be a parasitic, infectious disease, which is endemic in many places worldwide, like the Mediterranean countries, Iran, India, Australia, and South America. In step with World Health Organization (WHO), the annual incidence of Cystic Echinococcus is up to 220per 100,000 inhabitants in these countries [9].

Inclusion Criteria:-

1. Age group 10-60 yrs, all sex, occupation, religion
2. All the patients were admitted to the department of surgery with the diagnosis of Lung echinococcosis.
3. Patients giving consent to be a part of the study.
4. The patient who followed up a minimum of two years.

Exclusion Criteria:-

1. Patients having hydatidosis who have already undergone surgery previously.
2. Recurrent echinococcosis.
3. Patients who refused consent to be a part of the study.
4. Patients who didn't come for follow-up a minimum of one year.

The sample size was calculated using the formula through the department of statistics at Banaras Hindu University.

Where

-Z is that the z score at Confidence Interval 75% is 1.15

-ε is that the margin of error, assumed 5%

-p̂ is that the population proportion assumed 50%

This implies 133 or more measurements/surveys are needed to have& a confidence level of 75% that the 000 value is within ±5% of the measured/surveyed value. Ethical clearance was obtained from the moral committee of the Institute of Medical Sciences, Banaras Hindu University. Total 150 cases of intrathoracic masses were included, and this study was carried for two years after obtaining consent from each patient. This study was a prospective study. During this study, patients were investigated in systemic order include name, age, sex, position, occupation, address, and chief complaint. Their complaints with duration were noted. Progression of symptoms from the onset, development of latest symptoms and treatment taken before if any, history of tuberculosis, chronic cough, smoking, and contact were recorded.

Computed tomography: Performed for extent and precise location of mediastinal masses, small pulmonary lesions and extent of mediastinal lymphadenopathy, pathology of major vessels, and compression or displacement of esophagus.

Bronchoscopy: Bronchoscopy is a crucial method of investigation and in conjunction with radiology. It's the foremost helpful procedure concerning broncho pulmonary neoplasm. This can be meted out using either a rigid or flexible fiberoptic bronchoscope.

Instruments used are rigid bronchoscope which is actually a lightweight carrying tube with a connecting cable to a lightweight source. The instrument permits direct viewing of the inside of the larynx trachea and main segmental bronchi. An entire range of rigid bronchoscopes includes man and feminine, adolescent, child infant, and suckling. There are direct and angle telescopes that allow magnification and visualization of these bronchial openings, which don't seem to be in direct line of the bronchoscopic field of vision. Accessory includes straight and angle bronchial biopsy punches and foreign body extractors of various sizes.

Fig 2: Chest PA of 10 years old child showing hydatid cyst in the right lower lobe.

Fig 3: Solitary hydatid cyst in the left lower lobe with no reaction in adjacent lung tissue.

The present study includes 150 patients with intrathoracic space-occupying lesions, of which 24 patients with Hydatid cyst were seen at SS hospital Banaras Hindu University, Varanasi, UP. Most of the patients studied were from the thoracic surgery section, while few patients were taken from other departments of SS hospital. The age of those patients varied widely, starting from 10 years to 60 years. 

Table 1: - Age Distribution of Intrathoracic Lesions Cases

Maximum patients were in the age group of 41 to 50 years. The leading age group was 60 years, and the minimum age group was ten years.

Table 2:- Age Distribution of Hydatid Cyst Cases among Intrathoracic Lesions

Maximum age group 21-30 years, among which this has been observed. No cases were seen above 41 years of age.

Table 3: - Hemoglobin Pattern in Hydatid cyst cases

Hemoglobin was found adequate among the cases.

Table 4 :- Total Leucocytes Pattern in Hydatid cyst cases

Published studies during this field are only a few and limited to a minimal number of cases. This is often thanks to the chance of cystic rupture and, therefore, the spillage of its content during operation, resulting in recurrence within the future, and to the problem in controlling the accompanied bronchial fistulas and, consequently, the residual cavity, which increases complication rates and lengthen hospital stay. Such complications are also why some surgeons suggest preserving this system for dead cysts only [18]. Our study comprised 24 patients over 24 months. The maximum cohort among were 21-30 years, observed 50% of total cases. No cases were seen above 41 years old. In our study youngest was ten years, and also the oldest was 40 years. In a study, the mean age was 20.7 years [14].

In a study, the mean age was 24.3 years with nine years because the youngest and 72 years oldest patient among patients [15, 17]. Cough with/without expectoration (75%), pain (62.5%), and Dyspnoea (62.5%) were observed in the majority of cases. The same as the study by Lone, who reported pain (75%) [14]. The mean hemoglobin was 11.5 g/dl. Fifteen patients (62.5%) had raised total leukocyte count against 4% in Lone's study in Kashmir [14]. All patients received albendazole therapy 15 mg/kg/day for a minimum of 4–6 weeks before surgery [12]. In an exceedingly study on 21 patients with Echinococcosis who underwent albendazole treatment, some researchers found a 77.3% incidence of cyst rupture [19]. In our study, both lung involvements were seen in three patients (12.5%).

Biswas et al., in their study on 216 cases of pulmonary hydatids, found 42 patients with concomitant hepatic hydatid cysts (19.44%) and 18 patients with bilateral lung hydatids (8.33%) [15, 17]. Erdogan et al. studied 142 patients between 1990 and 2004 in Turkey and located 27 cases (19%) of lung and liver hydatid cysts and 12 cases (8.45%) of bilateral lung hydatids [20]. This shows that the share of both lung involvements in various series remains unaffected. All the cases underwent contrast-enhanced tomography of the thorax and, therefore, the upper abdomen in relevant cases. Twenty-one patients operated, and successful enucleation of the cyst was wiped out of eighteen cases. Three patients refused the surgery. Out of 21 cases that were operated on, 3 of them had infected cyst of left lower lobe treated as a case of chronic empyema after removal of ecto and endocyst.

Data analysis and interpretation: Dr Archana Mishra

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors